SLR - December 2009 - Susan King
Reference:
Potter, M.Q., Nunley, J.A. (2009). Long-Term Functional Outcomes After Operative Treatment for Intra-Articular Fractures of the Calcaneus. The Journal of Bone and Joint Surgery (American), 91, 1854-1860.
Scientific Literature Reviews
Reviewed by: Susan King
Residency Program: Botsford Hospital
Podiatric Relevance:
This study demonstrates the long-term outcomes of operative treatment of calcaneal fractures for a large cohort of patients.
Methods:
This was a retrospective review of seventy-three patients. All patients were treated with surgical management of intraarticular calcaneal fractures with screw and plate fixation between January 1, 1989 and April 30, 2003. All patients were evaluated with the use of a functional questionnaire that was administered by telephone that included the calcaneal fracture scoring system, the Foot Function Index, and the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale.
Results:
The 73 patients were followed for a median of 12.8 years. The mean adjusted AOFAS ankle-hindfoot score was 65.4 and the mean total Foot Function Index score was 20.5. The mean calcaneal fracture scoring system score was 69.3. Thirteen patients stated that had additional surgery on the injured foot, 7 had removal of painful hardware and three had I&D of a wound infection. Two went onto have an STJ arthrodesis and one had a tarsal tunnel release.
The patients receiving worker's compensation were then compared to those who did not. The AOFAS score for the workers' compensation group was 68.8 and 64.7 for the non-workers' compensation group. The Foot Function Index was 22.6 and 20.1 respectively. The calcaneal fracture scoring system was 68.7 and 69.4 respectively. One of the patients in the workers' compensation group and 12 of the non-workers' compensation group had additional surgery.
Patients who injured their foot after an MVA had an AOFAS score of 54.1 and those who had been injured from a fall had a score of 69.3. The Foot Function Index was 26.6 and 18.4 respectively. The calcaneal fracture scores were 61.3 and 70.0 respectively. Five of the patients who were injured in an MVA and 5 of the patients who had been injured from a fall went on to additional surgery.
Conclusions:
The long-term outcomes were found in this study to be similar to those in previous reports from a smaller patient population. However, they were not able to find a significant difference between the outcomes of patients receiving workers' compensation and those who were not, which was attributed to the small size of the subgroup. Finally, the authors found that patients who were injured after an MVA tended to have worse long-term outcomes than those who were injured from a fall. The authors attributed to this finding to the possibility that a patient who suffered an MVA may be more likely to have additional trauma and therefore more pain or that an MVA could represent a higher-energy trauma than a fall.
The authors noted that the study is limited since it is retrospective and lacked a population of control patients managed non-operatively.